H ·/ } / Oklahoma City County Health Department STD Lab and Overflow Visits August 2017 Oklahoma State Department of Health EXECUTIVE SUMMARY: Oklahoma State Department of Health (OSDH) is paying for the cost of STD lab and Issue #1: medication for Oklahoma County residents. Cleveland, Pottawatomie, Logan and Canadian counties are seeing a significant number Issue #2: of Oklahoma County residents and incurring the costs and administrative expenses of those clients. Some, but not all of the costs may be recouped from insurance payments. Specifics: • Each county has county millage or sales tax to support their public health departments and public health services. • County millage/sales tax is intended to support public health services for the residents of that county. o The county receiving the overflow incurs the costs of the staff, medications and other administrative costs • OSDH spends over $200,000 quarterly for STD lab testing for OKC County residents. 2017 lab costs for OCCHD clients were $823,918. • In 2017 OSDH spent $16,722.29 in STD medications supporting OKC County residents. • There is a significant overflow into OKC surrounding counties. STD visit cost is based on a Medicaid calculation of $49.27 per visit. Medication is not included. The net STD visits are: 653 visits less 93 visits from OSDH counties to OKC County= net visits of 560 x $49.27 = $27,591 The 2017 figures are to date for STD visits: o Cleveland-.34.4% or 367 visits ($18,082.09) • o Canadian - 30.5% or 96 visits ($4,729.92) o Logan - 37.1% or 170 visits ($8,375.90) • • o Oklahoma County- 1.8% or 32 visits were from Canadian County Oklahoma County-0.4 % or 12 visits were from Logan County Pottawatomie-4.7% or 20 visits ($985.40) • • Oklahoma County- 3.0% or 36 visits were from Cleveland County Oklahoma County- 0.4 % or 13 visits were from Pottawatomie County The following information is all visits inclusive of STD visits. The volume of clients from OKC County is significant enough that residents of Cleveland County are turned away for services. These visits may include anything from family planning to immunization to STD, etc. Many of these visits the cost is recovered through billing the insurance companies. There would be lost revenue for those visits that are not covered or for which OSDH is not contracted. It would take significant drill down of data to obtain that level of detail. Total visits are: 1 Oklahoma City County Health Department STD lab and Overflow Visits August 2017 o Cleveland-17.8% or 8,164 visits • Oklahoma County- 2.2% or 1,380 visits were from Cleveland County o Canadian -17.1% or 3,537 visits • Oklahoma County -1.5% or 1, 164 visits were from Canadian County o Logan - 27.3% or 2,633 visits o Pottawatomie - 3.9% or 418 visits • • Oklahoma County - 0.2% or 155 were from Logan County Oklahoma County-0.7% or 662 visits were from Pottawatomie County Recommendations: 1. OSDH will bill OCCHD for STD lab and medication on a monthly basis starting November 1, 2017. 2. OKC pays for the services for their citizens . OSDH will bill OCCHD the Medicaid rate of $49.27 for nurse visit/office visit for each STD visit in the 4 counties listed above less the number of OSDH visit seen OKC starting November 1, 2017. Billing will be on no less than a quarterly basis. Rates may change depending on the Oklahoma Health Care Authority Medicaid fee schedule. 3. The four counties will post information at their doors and registration encouraging Oklahoma County residents to seek services at one of the OKC sites. An information card will be developed to provide to those clients with the site location and contacts for OKC County sites. OSDH counties will not refuse to see a client if they choose not to go to another site. 2 Oklahoma City County Health Department STD Lab and Overflow Visits August 2017 CUSTOMER TEST # COST TOTAL AMOUNT TESTS OKLAHOMA_CHD_NRHC SYPH_RPR_OVRL $55 95 $ 527.25 SYPH_TPPA_OVRL $16.69 95 $ 1,585.55 190 $2,112.80 OKLAHOMA_CHD_NRHC Total OKLAHOMA_CHD_SOUTH SYPH_RPR_OVRL $5.55 111 $ 616.05 SYPH_TPPA_OVRL $16.69 111 $ 1,852.59 222 $ 2,468.64' OKLAHOMA_CHD_SOUTH Total OKLAHOMA_CHD_WEST SYPH_RPR_OVRL 5.55 22 $ 122.10 SYPH_TPPA_OVRL $16.69 22 $ 367.18 44 $ OKLAHOMA_CHD_WESTTotal OKLAHOMA_CHD_KELLEY CTGC_OVRL $44.25 54 $ 2,389.50 HIV_OVRL $11.20 25 $ 280.00 79 $ 2,669.50 • OKLAHOMA_CHD_KELLEY Total OKLAHOMA_CHD_NRHC CTGC_OVRL $44 .25 1,400 $61,950.00 HIV_1_2_SUPP $30.36 10 $ HIV_OVRL $11.20 608 $6,809.60 2,018 $69,063.201 OKLAHOMA_CHD_NRHC Total OKLAHOMA_CHD_SOUTH $44.25 1,712 $75,756.00 HIV_1_2_SUPP $30.36 4 $ HIV_OVRL $11.20 811 $9,083.20 2,527 $84,960.64 · OKLAHOMA_CHD_WEST Total 121.44 AFB_CLIN_SMEAR $6.79 79 $ 536.41 AFB_CULTURE $8.23 79 $ 650.17 $13.62 79 $ 1,075.98 AFB_GENPRB_MAC $25.29 1 $ 25.29 AFB_GENPRB_MTBC $25.29 3 $ 75.87 AFB_HPLC $15.79 20 $ 315.80 AFB_TB_PCR $44.25 2 $ 88.50 HIV_OVRL $11.20 68 $ 761.60 331 $ 3,529.62 OKLAHOMA_CHD_TB Total OKLAHOMA_CHD_WEST 303.60 CTGC_OVRL OKLAHOMA_CHD_SOUTH Total OKLAHOMA_CHD_ TB 489.28 I CTGC_OVRL $44.25 824 $36,462.00 HIV_1_2_SUPP $30.36 3 $ HIV_OVRL $11.20 369 $ 4,132.80 1,196 $ 40,685.88 · 91.08 OCCHD TOTAL 12ND QTR 2017 $205,979.56 OCCHO ANNUAL ESTIMATE $ 823,918.24 3 Oklahoma City County Health Department STD Lab and Overflow Visits August 2017 Cleveland County Out-of-Area Service Delivery SFYear = 2015 Client's County of Residence Cleveland Missing Oklahoma Other 29570 21 7267 3707 40565 1854 14 67310 4711 73889 County of Service Cleveland Frequency Oklahoma Frequency Total SFYear = 2016 Client's County of Residence Cleveland Missing Oklahoma Other 31155 13 7943 3617 42728 1884 18 71914 4587 78403 County of Service Cleveland Frequency Oklahoma Frequency Total SFYear = 2017 Client's County of Residence Cleveland Missing Oklahoma Other 34067 38 8164 3573 45842 1380 46 74917 3507 79850 County of Service Cleveland Frequency Oklahoma Frequency Total Client's County of Residence Year 2015 2016 2017 Combined Cleveland Oklahoma Other Missing County of Services Cleveland % % % % 72.9 17.9 9.1 0.05 Oklahoma 2.5 91.1 6.4 0.02 Cleveland 72.9 18.6 8.5 0.03 Oklahoma 2.4 91.7 5.9 0.02 Cleveland 74.3 17.8 7.8 0.08 Oklahoma 1.7 93.8 4.4 0.06 Cleveland 73.4 18.1 8.4 0.06 Oklahoma 2.2 92.2 5.5 0.03 4 Oklahoma City County Health Department STD Lab and Overflow Visits August 2017 Canadian County Out-of-Area Service Delivery SFYear = 2015 Client's County of Residence County of Service Canadian Frequency Oklahoma Frequency SFYear = 2016 Total canadian Missing Oklahoma Other 14783 18 3681 1781 20263 1830 14 67307 4742 73893 Client's County of Residence County of Service Canadian Frequency Oklahoma Frequency SFYear = 2017 Total canadian Missing Oklahoma Other 15154 25 3398 1533 20110 1831 18 71921 4637 78407 Client's County of Residence County of Service Canadian Frequency Oklahoma Frequency Total canadian Missing Oklahoma Other 15769 15 3537 1340 20661 1164 46 74928 3716 79854 Client's County of Residence Year 2015 2016 2017 Combined Canadian Oklahoma Other Missing % % % % Canadian 73.0 18.2 8.8 0.09 Oklahoma 2.5 91.1 6.4 0.02 Canadian 75.4 16.9 7.6 0.1 Oklahoma 2.3 91.7 5.9 0.02 Canadian 76.3 17.1 6.5 0.07 Oklahoma 1.5 93.8 4.7 0.06 Canadian 74.9 17.4 7.6 0.1 Oklahoma 2.1 92.3 5.6 0.03 County of Services 5 Oklahoma City County Health Department STD Lab and Overflow Visits August 2017 Logan County Out-of-Area Service Delivery SFYear = 2015 Client 's County of Residence County of Service Logan Frequency Oklahoma Frequency SFYear = 2016 Oklahoma Logan Missing Oklahoma Other 6334 8 2830 920 10092 194 14 67303 6383 73894 Client's County of Residence County of Service Logan Total Total Logan Missing Oklahoma Other 5701 24 2766 798 9289 201 18 71918 6262 78399 Frequency Frequency SFYear = 2017 Client's County of Residence County of Service Logan Frequency Oklahoma Frequency Total Logan Missing Oklahoma Other 6324 33 2633 649 9639 155 46 74921 4728 79850 Client's County of Residence Year 2015 County of Services Logan Oklahoma 2016 Logan Oklahoma 2017 Logan Oklahoma Combined Logan Oklahoma Logan Oklahoma Other Missing % % % % 62.8 28.0 9.1 0.1 0.3 91.1 8.6 0.02 61.4 29.8 8.6 0.3 0.3 91.7 8.0 0.02 65.6 27.3 6.7 0.3 0.2 93.8 5.9 0.06 63.3 28.4 8.2 0.2 0.2 92.3 7.5 0.03 6 Oklahoma City County Health Department STD Lab and Overflow Visits August 2017 Pottawatomie County Out-of-Area Service Delivery SFYear = 2015 Client's County of Residence County of Service Pottawatomie Frequency Oklahoma Frequency SFYear = 2016 Total Pottawatomie Missing Oklahoma Other 10016 12 675 2075 12778 485 14 67306 6085 73890 Client's County of Residence County of Service Pottawatomie Frequency Oklahoma Frequency SFYear = 2017 Total Pottawatomie Missing Oklahoma Other 9312 9 539 1681 11541 549 18 71922 5915 78404 Client's County of Residence County of Service Pottawatomie Frequency Oklahoma Frequency Total Pottawatomie Missing Oklahoma Other 8958 3 418 1388 10767 662 46 74920 4223 79851 Client's County of Residence Year 2015 Pottawatomie Oklahoma Other Missing % % % % 78.4 5.3 16.2 0.1 0.7 91.1 8.2 0.02 80.7 4.7 14.6 0.1 0.7 91.7 7.5 0.02 83.2 3.9 12.9 0.03 Oklahoma 0.8 93.8 5.3 0.1 Pottawatomie 80.6 4.7 14.7 0.1 0.7 92.3 7.0 0.03 County of Services Pottawatomie Oklahoma 2016 Pottawatomie Oklahoma 2017 Combined Pottawatomie Oklahoma 7 Oklahoma City County Health Department STD Lab and Overflow Visits August 2017 2017 STD Drugs for OCCHD Clients Paid from OSDH State-Appropriations OCCHD South Dru2 Bi!;;illin LA 1.2 MU 2ml Doxy:cy:cline 100mgL14ct Sterile water Inj Lidocaine 1°l'!l 30ml MDV CeftriaxQne SDV 25Qmg Azithrom:y:cin SOQmg tab EPTG Gentami!;;in 80mgL2ml vial Total cost DQses ent 450 88 2 17 370 688 100 78 18 Tgtal Cost $ 22.50 $ 375.76 $0.80 $12.75 $ 214.60 $3,935.36 $ 760 $2,325.96 $ 43.74 $7,691.47 Dose ent 180 45 TQtal Cost $ 9.00 $ 192.15 $0 $13.50 $ 63.80 $1,773.20 $ 380 $1,491 $ 21.87 $3,944.52 OCCHDWest Dru!:! Bi illin LA 1.2 MU 2ml Doxy:c:y:dine 100mgL14ct Sterile water Inj Lido!:;9 ine 1 °/Q 30ml MDV CeftriaxQne SDV 25Qmg Azithromy:cin SQQmg tab EPTC EPTG Gentami,in 8QmgL2ml vial Total CQSt 0 18 110 310 50 so 9 OCCHD NRHC Dru2 Bicillin LA 1.2 MU 2ml Doxy:c:y:!;;line 1QOmgL14!'.;;t Sterile water Inj Lidocaine 1°l'll 30ml MDV Ceftri;nmnP SDV 250mP" Azithrom:y:!;;in 500mg tab .E.IT.C EPTG Genta,mi in 8QmgL2ml vial Total CQSt Dgses sgnt 337 40 2 11 171 377 70 70 6 TQtal CQSt $16.85 $170.80 $0.80 $ 8.25 $ 99.18 $2,156.44 $ 532.00 $2,087.40 $ 14.58 $5,086.30 8 Oklahoma City County Health Department STD Lab and Overflow Visits August 2017 OCCHD Contracts PO 34090 21684 PROGRAM AREA CONTRACT PERIOD Protective Health Services 07/01/1706/30/18 Year 1 OF 1 Children First 07/01/1706/30/18 2 OF 5 Maternal & Child Health 07/ 01/1706/30/18 210WCX8 $306,841.00 400DK78 $250,000.00 $1,058,000.00 400GC88 198KFX8 $1,614,841.00 TOTAL Cl 34090 20009 $843,584.58 FUND $843,584.58 TOTALPHS 34090 21275 AMOUNT 3 OF 3 $79,614.00 198AR78 $231,097.00 198AR88 $45,215.00 400AR78 $135,643.00 400AR88 $303,500.00 400CC98 $381,554.00 400CM88 $127,184.00 400CM98 $22,118.00 400GF78 $68,724.00 400GF88 $22,118.00 198GF78 $68,724.00 198GF88 $111,356.00 198KFX8 TOTALMCH $1,596,847.00 TOTAL ALL PROGRAMS $4,055,272.58 9